Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis
Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis
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DOI：
10.1016/s1072-7515(03)00390-9
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发表时间：
2003-08-01
影响因子：
5.2
通讯作者：
Blumgart, L
中科院分区：
文献类型：
--
作者：
Martin, R;Paty, P;Blumgart, L
背景：治疗同时可切除的结直肠肝转移的最佳手术策略尚未确定。本研究的目的是回顾我们的经验与同步结直肠转移，并确定安全性的同时与分期切除的结肠和liver.Study设计：从1984年9月至2001年11月，240例手术治疗原发性大肠腺癌和同步肝转移。临床病理，手术和围手术期的数据进行了审查，以评估选择标准，手术方法和围手术期outcomes.Results：134例患者进行了同时切除的结直肠原发性和肝转移在一个单一的操作（组1），和106例患者进行分期手术（组11）。同时切除倾向于右半结肠原发灶（p < 0.001）、较小（p < 0.01）和较少（p < 0.001）肝转移灶以及不太广泛的肝切除（p < 0.001）。并发症在同时切除组中较少见，65例患者（49%）发生142例并发症，而分期切除组中71例患者（67%）发生197例并发症（p < 0.003）。同时切除的患者需要住院的天数更少（中位数10天vs 18天，p = 0.001）。围手术期死亡率相似（同时，n = 3;分期，n = 3）。结论：同时结肠和肝脏切除术是安全和有效的治疗结直肠癌和同步肝转移的患者。通过避免二次剖腹手术，总体并发症发生率降低，手术死亡率无变化。鉴于其发病率降低，治疗时间缩短，和类似的癌症结果，同时切除术应被认为是一个安全的选择，可切除的同步结直肠转移患者。(C)2003年由美国外科医生学会。
BACKGROUND: The optimal surgical strategy for the treatment of synchronous resectable colorectal liver metastasis has not been defined. The aims of this study were to review our experience with synchronous colorectal metastasis and to define the safety of simultaneous versus staged resection of the colon and liver.STUDY DESIGN: From September 1984 through November 2001, 240 patients were treated surgically for primary adenocarcinoma of the large bowel and synchronous hepatic metastasis. Clinicopathologic, operative, and perioperative data were reviewed to evaluate selection criteria, operative methods, and perioperative outcomes.RESULTS: One hundred thirty-four patients underwent simultaneous resection of a colorectal primary and hepatic metastasis in a single operation (Group 1), and 106 patients underwent staged operations (Group 11). Simultaneous resections tend to be performed for right colon primaries (p < 0.001), smaller (p < 0.01) and fewer (p < 0.001) liver metastases, and less extensive liver resection (p < 0.001). Complications were less common in the simultaneous resection group, with 65 patients (49%) sustaining 142 complications, compared with 71 patients (67%) sustaining 197 complications for both hospitalizations in the staged resection group (p < 0.003). Patients having simultaneous resection required fewer days in the hospital (median 10 days versus 18 days, p = 0.001). Perioperative mortality was similar (simultaneous, n = 3; staged, n = 3).CONCLUSIONS: Simultaneous colon and liver resection is safe and efficient in the treatment of patients with colorectal cancer and synchronous liver metastasis. By avoiding a second laparotomy, the overall complication rate is reduced, with no change in operative mortality. Given its reduced morbidity, shorter treatment time, and similar cancer outcomes, simultaneous resection should be considered a safe option in patients with resectable synchronous colorectal metastasis. (C) 2003 by the American College of Surgeons.